Robotic uterine manipulators with rollable sleeves

ABSTRACT

A uterine manipulator includes an elongated shaft, a colpotomy cup supported on the elongated shaft, a distal shaft extending distally from the colpotomy cup to a distal tip, and a rollable sleeve supported on the distal tip.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application Ser.No. 63/023,390, filed May 12, 2020, the entire contents of which areincorporated by reference herein.

TECHNICAL FIELD

This disclosure relates to hysterectomy and, more particularly, torobotic uterine manipulators.

BACKGROUND

Colpotomy, one of the final steps in a hysterectomy, requires making acircular incision in vaginal tissue to separate the uterus from thevagina with a cutting tool such as an electrosurgical instrument. Thisincision is typically performed with the aid of a uterine manipulator.Uterine manipulators are conventionally used during laparoscopichysterectomy procedures to position the vagina and the cervix tofacilitate separation and to enable removal of the uterus or othertissue specimens subsequent to performance of a colpotomy.

SUMMARY

In accordance with an aspect of this disclosure, a uterine manipulatorincludes an elongated shaft, a colpotomy cup supported on the elongatedshaft, a distal shaft, and a rollable sleeve. The distal shaft extendsdistally from the colpotomy cup to a distal tip. The rollable sleeve issupported on the distal tip.

In aspects, the rollable sleeve may include a body having a closeddistal end portion supported on the distal tip of the distal shaft, anda movable proximal end portion extending proximally from the closeddistal end portion. The movable proximal portion may be movable in aproximal direction relative to the closed distal end portion to elongatethe rollable sleeve. The movable proximal portion may uncoil as themovable proximal portion moves in a proximal direction relative to theclosed distal portion. The closed distal portion may elongate as themovable proximal portion uncoils.

In aspects, the rollable sleeve may be movable from a first position inwhich the rollable sleeve has a first length and a second position inwhich the rollable sleeve has a second length. The second length may belonger than the first length.

In aspects, the rollable sleeve may include a polymeric material. Therollable sleeve may be sufficiently elastic to expand away from thedistal shaft when the rollable sleeve receives inflation fluid within apocket defined by an inner surface of rollable sleeve.

In aspects, the rollable sleeve includes an inflatable balloon.

According to another aspect, a uterine manipulator system includes afluid source and a uterine manipulator. The uterine manipulator iscoupled to the fluid source. The uterine manipulator includes anelongated shaft, a colpotomy cup supported on the elongated shaft, adistal shaft extending distally from the colpotomy cup to a distal tip,and a rollable sleeve supported on the distal tip. The rollable sleeveis in fluid communication with the fluid source.

In aspects, the rollable sleeve may be sufficiently elastic to expandaway from the distal shaft when the rollable sleeve receives inflationfluid from the fluid source.

According to still another aspect, a robotic uterine manipulator systemincludes a robotic arm and a uterine manipulator supported on therobotic arm. The uterine manipulator includes an elongated shaft, acolpotomy cup supported on the elongated shaft, a distal shaft extendingdistally from the colpotomy cup to a distal tip, and a rollable sleevesupported on the distal tip.

Other aspects, features, and advantages will be apparent from thedescription, the drawings, and the claims that follow.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate aspects of this disclosure and,together with a general description of this disclosure given above, andthe detailed description given below, serve to explain the principles ofthis disclosure, wherein:

FIG. 1 is a perspective view of a robotic system in accordance with theprinciples of this disclosure;

FIG. 2 is an enlarged, perspective view of a proximal portion of arobotic uterine manipulator of the robotic colpotomy system of FIG. 1;

FIG. 3 is an enlarged, cross-sectional view of a rollable sleeve of therobotic uterine manipulator of FIG. 2;

FIGS. 4A-4C are progressive views of a distal portion of the roboticuterine manipulator which illustrate the rollable sleeve of FIG. 3 invarious positions relative to a distal shaft of the robotic uterinemanipulator;

FIGS. 5A-5D are progressive views illustrating the robotic uterinemanipulator being transvaginally inserted and the rollable sleevethereof being introduced into a uterus; and

FIGS. 6A and 6B are progressive views of another robotic uterinemanipulator having another distal shaft supporting the rollable sleeveof FIG. 3 and illustrating various positions of the rollable sleeve anddistal shaft relative to one another.

DETAILED DESCRIPTION

Aspects of this disclosure are described in detail with reference to thedrawings, in which like reference numerals designate identical orcorresponding elements in each of the several views. As used herein, theterm “distal” refers to that portion of structure farther from the user,while the term “proximal” refers to that portion of structure, closer tothe user. As used herein, the term “clinician” refers to a doctor,nurse, or other care provider and may include support personnel.

In the following description, well-known functions or constructions arenot described in detail to avoid obscuring the present disclosure inunnecessary detail.

Robotic surgical systems have been used in minimally invasive medicalprocedures and can include robotic arm assemblies. Such procedures maybe referred to as what is commonly referred to as “Telesurgery.” Somerobotic arm assemblies include one or more robot arms to which surgicalinstruments can be coupled. Such surgical instruments include, forexample, electrosurgical forceps, cutting instruments, staplers,graspers, electrocautery devices, or any other endoscopic or opensurgical devices. Prior to or during use of the robotic surgical system,various surgical instruments can be selected and connected to the robotarms for selectively actuating end effectors of the connected surgicalinstruments. Some of these surgical instruments utilize electricalenergy, for example, to effectuate electrocautery.

With reference to FIGS. 1 and 2, a robotic surgical system, such as therobotic colpotomy system 10 illustrated in FIG. 1, includes a roboticarm assembly 20 that supports a surgical instrument, such as a uterinemanipulator 100, for effectuating a surgical procedure (e.g., acolpotomy), an instrument drive unit 30 that imparts driving force touterine manipulator 100, and a sterile interface module 40 that enablesa proximal housing assembly 102 of uterine manipulator 100 to interfacewith instrument drive unit 30. This interface advantageously maintainssterility, provides a means to transmit electrical communication betweenrobotic colpotomy system 10 and uterine manipulator 100, provides ameans for transferring torque (e.g., rotational force) from roboticcolpotomy system 10 (e.g., IDU 30) to uterine manipulator 100 forperforming a function (e.g., sealing, cutting, manipulating, etc.) withuterine manipulator 100 and/or provides a means to selectivelyattach/remove uterine manipulator 100 to robotic colpotomy system 10(e.g., for rapid instrument exchange). For a more detailed descriptionof similar sterile interface modules and components thereof, referencecan be made to WO2017205308 by Zemlock et al., the entire contents ofwhich are incorporated by reference herein.

Robotic colpotomy system 10 further includes an energy source such as anelectrosurgical generator 50 that couples to uterine manipulator 100and/or any number of other surgical instruments such as anelectrosurgical probe or an electrocautery blade 60 via anelectrosurgical cable 99 and a connector assembly 104 supported bysterile interface module 40 and/or proximal housing assembly 102 ofuterine manipulator 100. For a more detailed description of one exampleof an electrosurgical generator, reference can be made to U.S. Pat. No.8,784,410, the entire contents of which are incorporated by referenceherein. For a more detailed description of one example of connectorassembly 104, reference can be made to U.S. Patent Application No.62/823,036, filed Mar. 25, 2019, and entitled “Robotic Surgical Systemswith Electrical Switch of Instrument Attachment,” the entire contents ofwhich are incorporated by reference herein. For a more detaileddescription of one example of an electrocautery blade 60, reference canbe made to U.S. Pat. Nos. 8,128,622 or 8,460,289, the entire contents ofeach of which are incorporated herein by reference.

Robotic colpotomy system 10 employs various robotic elements to assistthe clinician and allow remote operation (or partial remote operation)of surgical instrumentation such as uterine manipulator 100. Variousrobotic arms, gears, cams, pulleys, electric and mechanical motors, etc.may be employed for this purpose and may be designed with roboticcolpotomy system 10 to assist the clinician during the course of anoperation or treatment, and which can be included with, and/or part ofone or more drive mechanisms 106 of uterine manipulator 100, sterileinterface module 40, and/or instrument drive unit 30. Such roboticsystems may include remotely steerable systems, automatically flexiblesurgical systems, remotely flexible surgical systems, remotelyarticulating surgical systems, wireless surgical systems, modular orselectively configurable remotely operated surgical systems, etc.

Robotic colpotomy system 10 includes a medical work station (not shown)that may be employed with one or more consoles positioned next to theoperating theater or located in a remote location. In this instance, oneteam of clinicians may prep the patient for surgery and configurerobotic colpotomy system 10 with uterine manipulator 100 while anotherclinician (or group of clinicians) remotely controls uterine manipulator100 via the one or more consoles. As can be appreciated, a highlyskilled clinician may perform multiple operations in multiple locationswithout leaving his/her remote console. This can be economicallyadvantageous and a benefit to the patient or a series of patients. For adetailed description of exemplary medical work stations and/orcomponents thereof, reference may be made to U.S. Pat. No. 8,828,023 andPCT Application Publication No. WO2016/025132, the entire contents ofeach of which are incorporated by reference herein.

With continued reference to FIG. 1, robotic arm assembly 20 of roboticsurgical system 10 includes a cart 12 having robotic arms 22, 24, 26that are pivotally coupled together and movable together and/or relativeto one another and cart 12. Robotic arm 26 is coupled to a slide rail 28that supports instrument drive unit (“IDU”) 30 and sterile interfacemodule 40 for operating uterine manipulator 100. IDU 30 defines alongitudinal axis “L” and is slidably supported on slide rail 28 andselectively axially movable along longitudinal axis “L,” as indicated byarrows “A,” between a proximal position adjacent a proximal end portion28 a of slide rail 28, and a distal position adjacent a distal endportion 28 b of slide rail 28.

Robotic surgical system 10 can be in the form of an electrosurgicalcolpotomy system. In general, components of the electrosurgicalcolpotomy system can be used to effectuate a colpotomy. Briefly, whenusing a uterine manipulator for colpotomy during a laparoscopichysterectomy, a colpotomy cup can be used as a backstop for a clinicianto circumferentially cut along with a laparoscopic tool (e.g.,radiofrequency or “RF” tool) around the uterus.

With reference now to FIGS. 1-4C, uterine manipulator 100 includes anelongated shaft assembly 110 that extends from proximal housing assembly102 to a distal colpotomy assembly 120. Distal colpotomy assembly 120includes a colpotomy cup 130 and a distal shaft 122 that extendsdistally from colpotomy cup 130 to a distal tip 122 a. Distal shaft 122supports a rollable sleeve 124 on the distal tip 122 a thereof. Rollablesleeve 124 may be in the form of an inflatable balloon. Rollable sleeve124 includes a body 124 a having a closed distal end portion 124 bsupported on the distal tip 122 a of the distal shaft 122. Rollablesleeve 124 further includes a movable proximal end portion 124 cextending proximally from the closed distal end portion 124 b of body124 a and positioned to move relative to the closed distal end portion124 b between a coiled position (FIG. 4A) and an extended position (FIG.4B). Movable proximal end portion 124 c is configured to uncoil orunravel away from the closed distal end portion 124 b to elongaterollable sleeve 124 and/or coil toward closed distal end portion 124 bto shorten a length of rollable sleeve 124 (see, for example, FIGS.4A-4B). In particular, movable proximal end portion 124 c is configuredto roll and/or unroll in a spiral fashion with any number of rings orcoils concentrically arranged relative to one another). Rollable sleeve124 has an inner surface that defines a pocket 124 d for receivingdistal shaft 122 or portions thereof (e.g., distal tip 122 a) therein sothat rollable sleeve 124 frictionally constricts onto distal shaft 122for maintaining the rollable sleeve 124 secured to distal shaft 122while in either the coiled or extended positions thereof.

Rollable sleeve 124 can be formed of any suitable elastic material thathas sufficient elasticity to frictionally retain rollable sleeve 124distal shaft 122 (e.g., on distal tip 122 a thereof). Such material isalso expandable relative to distal shaft 122, for instance, wheninflation fluid “F” (e.g., saline; see FIG. 5D) is received withinpocket 124 d thereof. Rollable sleeve 124 is disposed in fluidcommunication with a fluid source 70 (e.g., saline) via a lumen 125defined through distal shaft 122 for selectively inflating rollablesleeve 124 to move rollable sleeve 124 from an uninflated position (FIG.4B) to an inflated position (FIG. 4C).

In aspects, rollable sleeve 124 can include any suitable polymericmaterial. For instance, such material can include an elastomericmaterial such as silicone rubber, polyurethane, polyester or the like.Rollable sleeve 124 may include any suitable biocompatible and/orbiodegradable material. Rollable sleeve 124 can include one or morebioactive agents supported on, and/or retained within, one or more innerand/or outer surfaces of rollable sleeve 124. Such bioactive agents canbe partially and/or wholly, impregnated, layered, and/or coated onand/or in one or more surfaces of rollable sleeve 124.

In use, as seen in FIGS. 5A-5D, distal tip 122 a is configured to beinserted, for example, with rollable sleeve 124 secured thereto (e.g.,frictionally retained thereon), into a cavity “C” of a patient's uterus“U” for inflating rollable sleeve 124 therein to secure distal colpotomyassembly 120 to the uterus “U” of the patient. As rollable sleeve 124engages cervical tissue “CT,” the cervical tissue “CT” will push themovable proximal end portion 124 c in a proximal direction relative tothe closed distal end portion 124 b, as indicated by arrows “A,” asuterine manipulator is advanced distally so to that movable proximal endportion 124 c uncoils toward the extended position of rollable sleeve124, lengthening rollable sleeve 124 along distal shaft 122. Onceuterine manipulator 100 is disposed in a desired position, for example,where colpotomy cup 130 is engaged with the cervical tissue “CT” anddistal shaft 122/rollable sleeve 124 are within the cavity “C” of thepatient's uterus “U,” inflation fluid “F” can be received within pocket124 d of rollable sleeve 124 to inflate rollable sleeve 124 in thecavity “C” and conform rollable sleeve 124 to cavity “C” to secureuterine manipulator 100 in position (FIG. 5D). Once uterine manipulator100 is secured, a colpotomy procedure can be effectuated. The rollablesleeve 124 can then be deflated as desired, for instance, by withdrawingdistal shaft 122 from the rollable sleeve 124 so that an open end 124 eof rollable sleeve 124 becomes exposed, releasing inflation fluid “F.”Rollable sleeve 124 can then be removed (e.g., via a graspingforceps—not shown) or left for biodegradation. Alternatively, inflationsource 70 may include or be coupled to a vacuum source for withdrawingthe inflation fluid “F” back through uterine manipulator 100 so thatproximal retraction of uterine manipulator 100 with draw rollable sleeve124 with uterine manipulator 100 once rollable sleeve 124 is deflated.

With reference to FIGS. 6A and 6B, in one aspect, distal tip 122 a maybe axially movable relative to distal shaft 122, as indicated by arrows“B,” to selectively elongate distal shaft 122 and facilitate anextension and/or coiling of rollable sleeve 124 relative distal shaft122, as indicated by arrows “A.” For instance, distal tip 122 a may bethreadably coupled to distal shaft 122 and/or axially slidable relativeto distal shaft 122 so that elongation may be effectuated via rotationand/or translation movement of distal tip 122 a relative to distal shaft122, where distal shaft 122 and/or distal tip 122 a are operativelycoupled to drive mechanism 106 via any suitable mechanical and/orelectrical components for causing such rotational and/or translationalmovement.

Further, although detailed herein with respect to a robotic system, thedisclosed uterine manipulators can be provided as manual and/orhand-held instruments. For a more detailed description of an exemplaryhand-held uterine manipulator, reference can be made to U.S. PatentApplication Publication No. 2018/0325554, the entire contents of whichare incorporated by reference herein.

As used herein, the term “biodegradable” in reference to a materialshall refer to the property of the material being able to be harmlesslyabsorbed by the body. In the present application, the terms“biodegradable,” “bioresorbable,” “bioerodable,” and “bioabsorbable” areused interchangeably and are intended to mean the characteristicaccording to which a material decomposes, or loses structural integrityunder body conditions (e.g., enzymatic degradation or hydrolysis) or arebroken down (physically or chemically) under physiologic conditions inthe body, such that the degradation products are excretable orabsorbable by the body after a given period of time. The time period mayvary, from about one hour to about several months or more, depending onthe chemical nature of the material. In embodiments, the material maynot be completely absorbed, provided the non-absorbed material poses nohealth risks and is biocompatible.

Further, the term “bioactive agent” includes “active therapeutic agent”(ATA) and can be used interchangeably. In its broadest sense, the term“bioactive agent” includes any substance or mixture of substances thathave clinical use. The bioactive agents may invoke a biological action,exert a biological effect, or play a role in one or more biologicalprocesses. Consequently, bioactive agents may or may not havepharmacological activity per se, e.g., a dye, or fragrance.Alternatively, a bioactive agent could be any agent that provides atherapeutic or prophylactic effect, a compound that affects orparticipates in tissue growth, cell growth, cell differentiation, ananti-adhesive compound, a compound that may be able to invoke abiological action such as an immune response, or could play any otherrole in one or more biological processes. The bioactive agent may beapplied to the disclosed structure in any suitable form of matter, e.g.,films, powders, liquids, gels and the like. The type and amount ofbioactive agent(s) used will depend, among other factors, on theparticular site and condition to be treated.

Examples of classes of bioactive agents which may be utilized inaccordance with the present disclosure include anti-adhesives,antimicrobials, analgesics, antipyretics, anesthetics, antiepileptics,antihistamines, anti-inflammatories, cardiovascular drugs, diagnosticagents, sympathomimetics, cholinomimetics, antimuscarinics,antispasmodics, hormones, growth factors, muscle relaxants, adrenergicneuron blockers, antineoplastics, immunogenic agents,immunosuppressants, gastrointestinal drugs, diuretics, steroids, lipids,lipopolysaccharides, polysaccharides, platelet activating drugs,clotting factors and enzymes. It is also intended that combinations ofbioactive agents may be used.

Anti-adhesive agents can be used to prevent adhesions from formingbetween the disclosed sleeves and the surrounding tissues opposite thetarget tissue. In addition, anti-adhesive agents may be used to preventadhesions from forming between the sleeves and packaging materialthereof. Some examples of these agents include, but are not limited tohydrophilic polymers such as poly(vinyl pyrrolidone), carboxymethylcellulose, hyaluronic acid, polyethylene oxide, poly vinyl alcohols, andcombinations thereof.

Suitable antimicrobial agents include triclosan, also known as2,4,4′-trichloro-2′-hydroxydiphenyl ether, chlorhexidine and its salts,including chlorhexidine acetate, chlorhexidine gluconate, chlorhexidinehydrochloride, and chlorhexidine sulfate, silver and its salts,including silver acetate, silver benzoate, silver carbonate, silvercitrate, silver iodate, silver iodide, silver lactate, silver laurate,silver nitrate, silver oxide, silver palmitate, silver protein, andsilver sulfadiazine, polymyxin, tetracycline, aminoglycosides, such astobramycin and gentamicin, rifampicin, bacitracin, neomycin,chloramphenicol, miconazole, quinolones such as oxolinic acid,norfloxacin, nalidixic acid, pefloxacin, enoxacin and ciprofloxacin,penicillins such as oxacillin and pipracil, nonoxynol 9, fusidic acid,cephalosporins, and combinations thereof. In addition, antimicrobialproteins and peptides such as bovine lactoferrin and lactoferricin B maybe included as a bioactive agent in a bioactive coating of thisdisclosure.

Other bioactive agents include: local anesthetics; non-steroidalantifertility agents; parasympathomimetic agents; psychotherapeuticagents; tranquilizers; decongestants; sedative hypnotics; steroids;sulfonamides; sympathomimetic agents; vaccines; vitamins, such asvitamin A, B-12, C, D, combinations thereof, and the like;antimalarials; anti-migraine agents; anti-parkinson agents such asL-dopa; anti-spasmodics; anticholinergic agents (e.g., oxybutynin);antitussives; bronchodilators; cardiovascular agents such as coronaryvasodilators and nitroglycerin; alkaloids; analgesics; narcotics such ascodeine, dihydrocodeinone, meperidine, morphine and the like;non-narcotics such as salicylates, aspirin, acetaminophen,d-propoxyphene and the like; opioid receptor antagonists, such asnaltrexone and naloxone; anti-cancer agents; anti-convulsants;anti-emetics; antihistamines; anti-inflammatory agents such as hormonalagents, hydrocortisone, prednisolone, prednisone, non-hormonal agents,allopurinol, indomethacin, phenylbutazone and the like; prostaglandinsand cytotoxic drugs; chemotherapeutics, estrogens; antibacterials;antibiotics; anti-fungals; anti-virals; anticoagulants; anticonvulsants;antidepressants; antihistamines; and immunological agents.

Other examples of suitable bioactive agents also include biologics andprotein therapeutics, such as, viruses, bacteria, lipids, amino acids,cells, peptides, polypeptides and proteins, analogs, muteins, and activefragments thereof, such as immunoglobulins, antibodies, cytokines (e.g.,lymphokines, monokines, chemokines), blood clotting factors, hemopoieticfactors, interleukins (IL-2, IL-3, IL-4, IL-6), interferons (β-IFN,α-IFN, and γ-IFN), erythropoietin, nucleases, tumor necrosis factor,colony stimulating factors (e.g., GCSF, GM-CSF, MCSF), insulin,anti-tumor agents and tumor suppressors, blood proteins, fibrin,thrombin, fibrinogen, synthetic thrombin, synthetic fibrin, syntheticfibrinogen, gonadotropins (e.g., FSH, LH, CG, etc.), hormones andhormone analogs (e.g., growth hormone), vaccines (e.g., tumoral,bacterial and viral antigens); somatostatin; antigens; blood coagulationfactors; growth factors (e.g., nerve growth factor, insulin-like growthfactor); bone morphogenic proteins, TGF-B, protein inhibitors, proteinantagonists, and protein agonists; nucleic acids, such as antisensemolecules, DNA, RNA, RNAi; oligonucleotides; polynucleotides; andribozymes.

Securement of any of the components of the disclosed devices may beeffectuated using known securement techniques such welding, crimping,gluing, fastening, etc.

Persons skilled in the art will understand that the structures andmethods specifically described herein and shown in the accompanyingfigures are non-limiting exemplary aspects, and that the description,disclosure, and figures should be construed merely as exemplary ofparticular aspects. It is to be understood, therefore, that thisdisclosure is not limited to the precise aspects described, and thatvarious other changes and modifications may be effectuated by oneskilled in the art without departing from the scope or spirit of thedisclosure. Additionally, the elements and features shown or describedin connection with certain aspects may be combined with the elements andfeatures of certain other aspects without departing from the scope ofthis disclosure, and that such modifications and variations are alsoincluded within the scope of this disclosure. Accordingly, the subjectmatter of this disclosure is not limited by what has been particularlyshown and described.

What is claimed is:
 1. A uterine manipulator comprising: an elongated shaft; a colpotomy cup supported on the elongated shaft; a distal shaft extending distally from the colpotomy cup to a distal tip; and a rollable sleeve supported on the distal tip.
 2. The uterine manipulator of claim 1, wherein the rollable sleeve includes a body having a closed distal end portion supported on the distal tip of the distal shaft, and a movable proximal end portion extending proximally from the closed distal end portion.
 3. The uterine manipulator of claim 1, wherein the rollable sleeve is movable from a first position in which the rollable sleeve has a first length and a second position in which the rollable sleeve has a second length.
 4. The uterine manipulator of claim 3, wherein the second length is longer than the first length.
 5. The uterine manipulator of claim 2, wherein the movable proximal portion is movable in a proximal direction relative to the closed distal end portion to elongate the rollable sleeve.
 6. The uterine manipulator of claim 5, wherein the movable proximal portion uncoils as the movable proximal portion moves in a proximal direction relative to the closed distal portion.
 7. The uterine manipulator of claim 6, wherein the closed distal portion elongates as the movable proximal portion uncoils.
 8. The uterine manipulator of claim 1, wherein the rollable sleeve includes a polymeric material.
 9. The uterine manipulator of claim 8, wherein the rollable sleeve is sufficiently elastic to expand away from the distal shaft when the rollable sleeve receives inflation fluid within a pocket defined by an inner surface of rollable sleeve.
 10. The uterine manipulator of claim 1, wherein the rollable sleeve includes an inflatable balloon.
 11. A uterine manipulator system comprising: a fluid source; and a uterine manipulator coupled to the fluid source, the uterine manipulator including: an elongated shaft; a colpotomy cup supported on the elongated shaft; a distal shaft extending distally from the colpotomy cup to a distal tip; and a rollable sleeve supported on the distal tip, the rollable sleeve in fluid communication with the fluid source.
 12. The uterine manipulator system of claim 11, wherein the rollable sleeve includes a body having a closed distal end portion supported on the distal tip of the distal shaft, and a movable proximal end portion extending proximally from the closed distal end portion.
 13. The uterine manipulator system of claim 11, wherein the rollable sleeve is movable from a first position in which the rollable sleeve has a first length and a second position in which the rollable sleeve has a second length.
 14. The uterine manipulator system of claim 13, wherein the second length is longer than the first length.
 15. The uterine manipulator system of claim 12, wherein the movable proximal portion is movable in a proximal direction relative to the closed distal end portion to elongate the rollable sleeve.
 16. The uterine manipulator system of claim 15, wherein the movable proximal portion uncoils as the movable proximal portion moves in a proximal direction relative to the closed distal portion.
 17. The uterine manipulator system of claim 16, wherein the closed distal portion elongates as the movable proximal portion uncoils.
 18. The uterine manipulator system of claim 11, wherein the rollable sleeve includes a polymeric material.
 19. The uterine manipulator system of claim 18, wherein the rollable sleeve is sufficiently elastic to expand away from the distal shaft when the rollable sleeve receives inflation fluid from the fluid source.
 20. A robotic uterine manipulator system comprising: a robotic arm; and a uterine manipulator supported on the robotic arm, the uterine manipulator including: an elongated shaft; a colpotomy cup supported on the elongated shaft; a distal shaft extending distally from the colpotomy cup to a distal tip; and a rollable sleeve supported on the distal tip. 